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Overview of nontuberculous mycobacterial pulmonary infections in children

Author
Andrea T Cruz, MD, MPH
Section Editor
Sheldon L Kaplan, MD
Deputy Editor
Mary M Torchia, MD

INTRODUCTION

Nontuberculous mycobacteria (NTM) are a miscellaneous collection of acid-fast bacteria that are widespread in the environment [1]. They have been isolated from numerous environmental sources including water, soil, food products, and domestic and wild animals [2]. Healthcare-associated transmission has occurred with medical equipment [3-5].

More than 130 species of have been identified, not all of which have been documented to cause disease in humans [6-9]. NTM pathogens are classified as rapidly growing or slowly growing (table 1). Rapidly growing species grow within seven days and include Mycobacterium fortuitum, M. abscessus, and M. chelonae. Slowly growing species require several weeks to grow and include M. avium complex (MAC), M. marinum, and M. kansasii. (See "Microbiology of nontuberculous mycobacteria", section on 'Classification'.)

NTM can cause a broad range of infections that vary depending on the particular NTM species and the host. In children, NTM cause four main clinical syndromes: lymphadenopathy, skin and soft tissue infection (SSTI), pulmonary disease (predominantly in children with underlying pulmonary conditions), and disseminated disease (predominantly in immune-compromised children).

This topic will provide an overview of NTM pulmonary infections in children. NTM lymphadenitis, SSTI, disseminated infection, and bacteremia in children are discussed separately. (See "Overview of nontuberculous mycobacterial lymphadenitis in children" and "Overview of nontuberculous mycobacterial skin and soft tissue infections in children" and "Overview of disseminated nontuberculous mycobacterial (NTM) infections and NTM bacteremia in children".)

MICROBIOLOGY

The most common NTM species causing pulmonary disease in adults in the United States are M. avium complex (MAC, M. avium and M. intracellulare), M. abscessus, and M. kansasii [10]. Few data are available for children. However, MAC and M. abscessus are the species most frequently isolated from children with cystic fibrosis [11-15]. In one series of 17 children with NTM pulmonary disease, MAC was more common in previously healthy children (n = 5) and M. abscessus or M. chelonae in children with cystic fibrosis (n = 8) [16].

                        

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Literature review current through: Nov 2016. | This topic last updated: Thu Sep 29 00:00:00 GMT 2016.
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References
Top
  1. Fraser L, Moore P, Kubba H. Atypical mycobacterial infection of the head and neck in children: a 5-year retrospective review. Otolaryngol Head Neck Surg 2008; 138:311.
  2. Griffith DE, Aksamit T, Brown-Elliott BA, et al. An official ATS/IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases. Am J Respir Crit Care Med 2007; 175:367.
  3. Celdrán A, Esteban J, Mañas J, Granizo JJ. Wound infections due to Mycobacterium fortuitum after polypropylene mesh inguinal hernia repair. J Hosp Infect 2007; 66:374.
  4. Ferguson DD, Gershman K, Jensen B, et al. Mycobacterium goodii infections associated with surgical implants at Colorado hospital. Emerg Infect Dis 2004; 10:1868.
  5. Al Soub H, Al Maslamani M, Al Khuwaiter J, et al. Myocardial abscess and bacteremia complicating Mycobacterium fortuitum pacemaker infection: case report and review of the literature. Pediatr Infect Dis J 2009; 28:1032.
  6. McNabb A, Eisler D, Adie K, et al. Assessment of partial sequencing of the 65-kilodalton heat shock protein gene (hsp65) for routine identification of Mycobacterium species isolated from clinical sources. J Clin Microbiol 2004; 42:3000.
  7. Tortoli E. Impact of genotypic studies on mycobacterial taxonomy: the new mycobacteria of the 1990s. Clin Microbiol Rev 2003; 16:319.
  8. Mycobacterium. List of prokaryotic names with standing in nomenclature. www.bacterio.cict.fr/m/mycobacterium.html (Accessed on July 21, 2012).
  9. American Academy of Pediatrics. Diseases caused by nontuberculous mycobacteria. In: Red Book: 2015 Report of the Committee on Infectious Diseases, 30th ed, Kimberlin DW, Brady MT, Jackson MA, Long SS (Eds), American Academy of Pediatrics, Elk Grove Village, IL 2015. p.831.
  10. Winthrop KL, Albridge K, South D, et al. The clinical management and outcome of nail salon-acquired Mycobacterium fortuitum skin infection. Clin Infect Dis 2004; 38:38.
  11. Roux AL, Catherinot E, Ripoll F, et al. Multicenter study of prevalence of nontuberculous mycobacteria in patients with cystic fibrosis in france. J Clin Microbiol 2009; 47:4124.
  12. Esther CR Jr, Henry MM, Molina PL, Leigh MW. Nontuberculous mycobacterial infection in young children with cystic fibrosis. Pediatr Pulmonol 2005; 40:39.
  13. Levy I, Grisaru-Soen G, Lerner-Geva L, et al. Multicenter cross-sectional study of nontuberculous mycobacterial infections among cystic fibrosis patients, Israel. Emerg Infect Dis 2008; 14:378.
  14. Olivier KN, Weber DJ, Wallace RJ Jr, et al. Nontuberculous mycobacteria. I: multicenter prevalence study in cystic fibrosis. Am J Respir Crit Care Med 2003; 167:828.
  15. Pierre-Audigier C, Ferroni A, Sermet-Gaudelus I, et al. Age-related prevalence and distribution of nontuberculous mycobacterial species among patients with cystic fibrosis. J Clin Microbiol 2005; 43:3467.
  16. Cruz AT, Ong LT, Starke JR. Mycobacterial infections in Texas children: a 5-year case series. Pediatr Infect Dis J 2010; 29:772.
  17. Wolinsky E. Mycobacterial lymphadenitis in children: a prospective study of 105 nontuberculous cases with long-term follow-up. Clin Infect Dis 1995; 20:954.
  18. Chesney PJ. Nontuberculous mycobacteria. Pediatr Rev 2002; 23:300.
  19. Grange JM, Yates MD, Pozniak A. Bacteriologically confirmed non-tuberculous mycobacterial lymphadenitis in south east England: a recent increase in the number of cases. Arch Dis Child 1995; 72:516.
  20. Pham-Huy A, Robinson JL, Tapiéro B, et al. Current trends in nontuberculous mycobacteria infections in Canadian children: A pediatric investigators collaborative network on infections in Canada (PICNIC) study. Paediatr Child Health 2010; 15:276.
  21. Vu TT, Daniel SJ, Quach C. Nontuberculous mycobacteria in children: a changing pattern. J Otolaryngol 2005; 34 Suppl 1:S40.
  22. Fauroux B, Delaisi B, Clément A, et al. Mycobacterial lung disease in cystic fibrosis: a prospective study. Pediatr Infect Dis J 1997; 16:354.
  23. Whittaker LA, Teneback C. Atypical mycobacterial and fungal infections in cystic fibrosis. Semin Respir Crit Care Med 2009; 30:539.
  24. Holland SM. Interferon gamma, IL-12, IL-12R and STAT-1 immunodeficiency diseases: disorders of the interface of innate and adaptive immunity. Immunol Res 2007; 38:342.
  25. Marazzi MG, Chapgier A, Defilippi AC, et al. Disseminated Mycobacterium scrofulaceum infection in a child with interferon-gamma receptor 1 deficiency. Int J Infect Dis 2010; 14:e167.
  26. Tsolia MN, Chapgier A, Taprantzi P, et al. Disseminated nontuberculous mycobacterial infection in a child with interferon-gamma receptor 1 deficiency. Eur J Pediatr 2006; 165:458.
  27. Koscielniak E, de Boer T, Dupuis S, et al. Disseminated Mycobacterium peregrinum infection in a child with complete interferon-gamma receptor-1 deficiency. Pediatr Infect Dis J 2003; 22:378.
  28. Vesterhus P, Holland SM, Abrahamsen TG, Bjerknes R. Familial disseminated infection due to atypical mycobacteria with childhood onset. Clin Infect Dis 1998; 27:822.
  29. Colombo RE, Hill SC, Claypool RJ, et al. Familial clustering of pulmonary nontuberculous mycobacterial disease. Chest 2010; 137:629.
  30. Koh WJ, Kwon OJ, Kim EJ, et al. NRAMP1 gene polymorphism and susceptibility to nontuberculous mycobacterial lung diseases. Chest 2005; 128:94.
  31. Unal E, Yen C, Saiman L, et al. A low incidence of nontuberculous mycobacterial infections in pediatric hematopoietic stem cell transplantation recipients. Biol Blood Marrow Transplant 2006; 12:1188.
  32. Wu UI, Holland SM. Host susceptibility to non-tuberculous mycobacterial infections. Lancet Infect Dis 2015; 15:968.
  33. Aronchick JM, Miller WT Jr. Disseminated nontuberculous mycobacterial infections in immunosuppressed patients. Semin Roentgenol 1993; 28:150.
  34. Mofenson LM, Brady MT, Danner SP, et al. Guidelines for the Prevention and Treatment of Opportunistic Infections among HIV-exposed and HIV-infected children: recommendations from CDC, the National Institutes of Health, the HIV Medicine Association of the Infectious Diseases Society of America, the Pediatric Infectious Diseases Society, and the American Academy of Pediatrics. MMWR Recomm Rep 2009; 58:1.
  35. Griffith DE, Girard WM, Wallace RJ Jr. Clinical features of pulmonary disease caused by rapidly growing mycobacteria. An analysis of 154 patients. Am Rev Respir Dis 1993; 147:1271.
  36. Tebruegge M, Curtis N. Mycobacterium species non-tuberculosis. In: Principles and Practice of Pediatric Infectious Diseases, 4th ed, Long SS, Pickering LK, Prober CG (Eds), Elsevier Saunders, Edinburgh 2012. p.786.
  37. Nolt D, Michaels MG, Wald ER. Intrathoracic disease from nontuberculous mycobacteria in children: two cases and a review of the literature. Pediatrics 2003; 112:e434.
  38. Esther CR Jr, Esserman DA, Gilligan P, et al. Chronic Mycobacterium abscessus infection and lung function decline in cystic fibrosis. J Cyst Fibros 2010; 9:117.
  39. Freeman AF, Olivier KN, Rubio TT, et al. Intrathoracic nontuberculous mycobacterial infections in otherwise healthy children. Pediatr Pulmonol 2009; 44:1051.
  40. Kröner C, Griese M, Kappler M, et al. Endobronchial lesions caused by nontuberculous mycobacteria in apparently healthy pediatric patients. Pediatr Infect Dis J 2015; 34:532.
  41. Murillo J, Torres J, Bofill L, et al. Skin and wound infection by rapidly growing mycobacteria: an unexpected complication of liposuction and liposculpture. The Venezuelan Collaborative Infectious and Tropical Diseases Study Group. Arch Dermatol 2000; 136:1347.
  42. Somoskovi A, Mester J, Hale YM, et al. Laboratory diagnosis of nontuberculous mycobacteria. Clin Chest Med 2002; 23:585.
  43. Butler WR, Ahearn DG, Kilburn JO. High-performance liquid chromatography of mycolic acids as a tool in the identification of Corynebacterium, Nocardia, Rhodococcus, and Mycobacterium species. J Clin Microbiol 1986; 23:182.
  44. Nahid P, Dorman SE, Alipanah N, et al. Official American Thoracic Society/Centers for Disease Control and Prevention/Infectious Diseases Society of America Clinical Practice Guidelines: Treatment of Drug-Susceptible Tuberculosis. Clin Infect Dis 2016; 63:e147.
  45. Magis-Escurra C, Alffenaar JW, Hoefnagels I, et al. Pharmacokinetic studies in patients with nontuberculous mycobacterial lung infections. Int J Antimicrob Agents 2013; 42:256.
  46. Hafner R, Bethel J, Power M, et al. Tolerance and pharmacokinetic interactions of rifabutin and clarithromycin in human immunodeficiency virus-infected volunteers. Antimicrob Agents Chemother 1998; 42:631.
  47. Waters V, Ratjen F. Antibiotic treatment for nontuberculous mycobacteria lung infection in people with cystic fibrosis. Cochrane Database Syst Rev 2014; :CD010004.
  48. Griffith DE, Brown BA, Girard WM, et al. Azithromycin-containing regimens for treatment of Mycobacterium avium complex lung disease. Clin Infect Dis 2001; 32:1547.
  49. Griffith DE, Brown BA, Murphy DT, et al. Initial (6-month) results of three-times-weekly azithromycin in treatment regimens for Mycobacterium avium complex lung disease in human immunodeficiency virus-negative patients. J Infect Dis 1998; 178:121.
  50. Griffith DE, Brown BA, Cegielski P, et al. Early results (at 6 months) with intermittent clarithromycin-including regimens for lung disease due to Mycobacterium avium complex. Clin Infect Dis 2000; 30:288.
  51. Peloquin CA, Berning SE, Nitta AT, et al. Aminoglycoside toxicity: daily versus thrice-weekly dosing for treatment of mycobacterial diseases. Clin Infect Dis 2004; 38:1538.
  52. Wallace RJ Jr, Brown BA, Griffith DE, et al. Clarithromycin regimens for pulmonary Mycobacterium avium complex. The first 50 patients. Am J Respir Crit Care Med 1996; 153:1766.
  53. Tanaka E, Kimoto T, Tsuyuguchi K, et al. Effect of clarithromycin regimen for Mycobacterium avium complex pulmonary disease. Am J Respir Crit Care Med 1999; 160:866.
  54. Shitrit D, Baum GL, Priess R, et al. Pulmonary Mycobacterium kansasii infection in Israel, 1999-2004: clinical features, drug susceptibility, and outcome. Chest 2006; 129:771.
  55. da Silva Telles MA, Chimara E, Ferrazoli L, Riley LW. Mycobacterium kansasii: antibiotic susceptibility and PCR-restriction analysis of clinical isolates. J Med Microbiol 2005; 54:975.
  56. Guna R, Muñoz C, Domínguez V, et al. In vitro activity of linezolid, clarithromycin and moxifloxacin against clinical isolates of Mycobacterium kansasii. J Antimicrob Chemother 2005; 55:950.
  57. Alcaide F, Calatayud L, Santín M, Martín R. Comparative in vitro activities of linezolid, telithromycin, clarithromycin, levofloxacin, moxifloxacin, and four conventional antimycobacterial drugs against Mycobacterium kansasii. Antimicrob Agents Chemother 2004; 48:4562.
  58. Pezzia W, Raleigh JW, Bailey MC, et al. Treatment of pulmonary disease due to Mycobacterium kansasii: recent experience with rifampin. Rev Infect Dis 1981; 3:1035.
  59. Ahn CH, Lowell JR, Ahn SS, et al. Chemotherapy for pulmonary disease due to Mycobacterium kansasii: efficacies of some individual drugs. Rev Infect Dis 1981; 3:1028.
  60. Ahn CH, Lowell JR, Ahn SS, et al. Short-course chemotherapy for pulmonary disease caused by Mycobacterium kansasii. Am Rev Respir Dis 1983; 128:1048.
  61. Banks J, Hunter AM, Campbell IA, et al. Pulmonary infection with Mycobacterium kansasii in Wales, 1970-9: review of treatment and response. Thorax 1983; 38:271.
  62. Brenner DJ, Hall EJ. Computed tomography--an increasing source of radiation exposure. N Engl J Med 2007; 357:2277.